Evidence Rounds
@evidencerounds.bsky.social
News you can use in hospital medicine
Medical literature is doubling rapidly, but knowledge isn't. Too many studies fail to answer the questions that matter most. We find and appraise the rare practice-changing evidence and cutting edge ideas.
Medical literature is doubling rapidly, but knowledge isn't. Too many studies fail to answer the questions that matter most. We find and appraise the rare practice-changing evidence and cutting edge ideas.
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Welcome to Evidence Rounds!
You might be an Evidence Rounder if you drown in literature that rarely helps and want trustworthy, curated evidence
Follow for weekly updates featuring practice-changing studies and the most promising ideas that shape hospital medicine
You might be an Evidence Rounder if you drown in literature that rarely helps and want trustworthy, curated evidence
Follow for weekly updates featuring practice-changing studies and the most promising ideas that shape hospital medicine
Two recent trials challenged the historical preference for anti-staphylococcal penicillin. For MSSA bacteremia, cefazolin should be first-line, and when the isolate is penicillin susceptible, benzylpenicillin is the preferred narrow-spectrum option
August 27, 2026 at 8:26 PM
Two recent trials challenged the historical preference for anti-staphylococcal penicillin. For MSSA bacteremia, cefazolin should be first-line, and when the isolate is penicillin susceptible, benzylpenicillin is the preferred narrow-spectrum option
In a proof-of-concept AI second opinion study of 76 ED visits, an LLM exceeded 2 independent MD reviewers on diagnostic performance at 3 touchpoints (ER triage, ER physician & admit)
Whether it outperforms physicians in real-world practice is yet to be determined
Whether it outperforms physicians in real-world practice is yet to be determined
May 18, 2026 at 7:24 PM
In a proof-of-concept AI second opinion study of 76 ED visits, an LLM exceeded 2 independent MD reviewers on diagnostic performance at 3 touchpoints (ER triage, ER physician & admit)
Whether it outperforms physicians in real-world practice is yet to be determined
Whether it outperforms physicians in real-world practice is yet to be determined
In a double-blind RCT of 108 obese AUD pts motivated for sobriety, semaglutide reduced heavy drinking days by 13% (absolute) vs placebo
Reduction in drinking strongly correlated w/ weight los
Suggests shared mechanism or functional unblinding, which might exaggerate benefits
Reduction in drinking strongly correlated w/ weight los
Suggests shared mechanism or functional unblinding, which might exaggerate benefits
May 14, 2026 at 5:25 PM
In a double-blind RCT of 108 obese AUD pts motivated for sobriety, semaglutide reduced heavy drinking days by 13% (absolute) vs placebo
Reduction in drinking strongly correlated w/ weight los
Suggests shared mechanism or functional unblinding, which might exaggerate benefits
Reduction in drinking strongly correlated w/ weight los
Suggests shared mechanism or functional unblinding, which might exaggerate benefits
Do patients on a low dose of levothyroxine truly have hypothyroidism?
In a multicenter longitudinal descriptive study, 64% on a levothyroxine dose of 50 µg/d or lower were able to successfully discontinue treatment, suggesting that very low doses more often reflect overtreatment
In a multicenter longitudinal descriptive study, 64% on a levothyroxine dose of 50 µg/d or lower were able to successfully discontinue treatment, suggesting that very low doses more often reflect overtreatment
April 24, 2026 at 7:48 PM
Do patients on a low dose of levothyroxine truly have hypothyroidism?
In a multicenter longitudinal descriptive study, 64% on a levothyroxine dose of 50 µg/d or lower were able to successfully discontinue treatment, suggesting that very low doses more often reflect overtreatment
In a multicenter longitudinal descriptive study, 64% on a levothyroxine dose of 50 µg/d or lower were able to successfully discontinue treatment, suggesting that very low doses more often reflect overtreatment
Does hydration reduce kidney stones?
A behavioral intervention ↑ fluid intake ~300 mL (w/ slight ↑ urinary symptoms) but did NOT ↓ recurrence or improve outcomes
Intake difference may have been too small, as a prior small trial showed benefit w larger separation (~2.5 vs 1L)
A behavioral intervention ↑ fluid intake ~300 mL (w/ slight ↑ urinary symptoms) but did NOT ↓ recurrence or improve outcomes
Intake difference may have been too small, as a prior small trial showed benefit w larger separation (~2.5 vs 1L)
April 22, 2026 at 4:28 PM
Does hydration reduce kidney stones?
A behavioral intervention ↑ fluid intake ~300 mL (w/ slight ↑ urinary symptoms) but did NOT ↓ recurrence or improve outcomes
Intake difference may have been too small, as a prior small trial showed benefit w larger separation (~2.5 vs 1L)
A behavioral intervention ↑ fluid intake ~300 mL (w/ slight ↑ urinary symptoms) but did NOT ↓ recurrence or improve outcomes
Intake difference may have been too small, as a prior small trial showed benefit w larger separation (~2.5 vs 1L)
Minocycline for acute ischemic stroke?
In a multicenter RCT, oral minocycline within 72h of an ischemic stroke (NIHSS 4–25) improved functioning at 90 days (mRS 0–1: 52.6% vs 47.4%; ~5% absolute; RR 1.11), supporting a modest neuroprotective benefit
In a multicenter RCT, oral minocycline within 72h of an ischemic stroke (NIHSS 4–25) improved functioning at 90 days (mRS 0–1: 52.6% vs 47.4%; ~5% absolute; RR 1.11), supporting a modest neuroprotective benefit
April 11, 2026 at 4:19 PM
Minocycline for acute ischemic stroke?
In a multicenter RCT, oral minocycline within 72h of an ischemic stroke (NIHSS 4–25) improved functioning at 90 days (mRS 0–1: 52.6% vs 47.4%; ~5% absolute; RR 1.11), supporting a modest neuroprotective benefit
In a multicenter RCT, oral minocycline within 72h of an ischemic stroke (NIHSS 4–25) improved functioning at 90 days (mRS 0–1: 52.6% vs 47.4%; ~5% absolute; RR 1.11), supporting a modest neuroprotective benefit
In a head-to-head trial for VTE treatment, apixaban was safer than rivaroxaban with similar effecacy at 90 days, with ~4% less clinically relevant bleeding (RR 0.5)
Since the safety advantage was confined to the loading-dose phase, its not relevant for atrial fibrillation
Since the safety advantage was confined to the loading-dose phase, its not relevant for atrial fibrillation
March 26, 2026 at 2:36 PM
In a head-to-head trial for VTE treatment, apixaban was safer than rivaroxaban with similar effecacy at 90 days, with ~4% less clinically relevant bleeding (RR 0.5)
Since the safety advantage was confined to the loading-dose phase, its not relevant for atrial fibrillation
Since the safety advantage was confined to the loading-dose phase, its not relevant for atrial fibrillation
The SOHO trial confirms the use of high-flow nasal cannula for acute hypoxic respiratory failure with less intubation (NNT ~17; benefit by day 1, plateaus by day 4) and less dyspnea (NNT ~7; ~5-point improvement on a 100-point scale)
March 24, 2026 at 4:44 PM
The SOHO trial confirms the use of high-flow nasal cannula for acute hypoxic respiratory failure with less intubation (NNT ~17; benefit by day 1, plateaus by day 4) and less dyspnea (NNT ~7; ~5-point improvement on a 100-point scale)
Should longer vanc courses be prescribed for first episodes of C diff?
In a Bayesian RCT, a 4-week pulse+taper reduced recurrence vs standard 2-week course at 1 month (RRR 43%, 99% probability of superiority) and at 2 mos (RRR 16%, 74% prob)
But 3-month recurrence was similar
In a Bayesian RCT, a 4-week pulse+taper reduced recurrence vs standard 2-week course at 1 month (RRR 43%, 99% probability of superiority) and at 2 mos (RRR 16%, 74% prob)
But 3-month recurrence was similar
March 19, 2026 at 3:28 PM
Should longer vanc courses be prescribed for first episodes of C diff?
In a Bayesian RCT, a 4-week pulse+taper reduced recurrence vs standard 2-week course at 1 month (RRR 43%, 99% probability of superiority) and at 2 mos (RRR 16%, 74% prob)
But 3-month recurrence was similar
In a Bayesian RCT, a 4-week pulse+taper reduced recurrence vs standard 2-week course at 1 month (RRR 43%, 99% probability of superiority) and at 2 mos (RRR 16%, 74% prob)
But 3-month recurrence was similar
Does correcting chronic hyponatremia improve outcomes? In an RCT of hospitalized adults with Na <130, a targeted correction algorithm did not improve 30-day death/rehospitalization (20.5% vs 21.8%) or neurocognitive outcomes...
March 17, 2026 at 3:04 PM
Does correcting chronic hyponatremia improve outcomes? In an RCT of hospitalized adults with Na <130, a targeted correction algorithm did not improve 30-day death/rehospitalization (20.5% vs 21.8%) or neurocognitive outcomes...
Treating addiction is hard
In a pragmatic RCT of patients with nonfatal opioid overdose, ED peer navigators did not reduce 1-year outcomes
This builds on a prior step-wedge cluster RCT: addiction consult increased med use, but 6-month retention was low & similar (2.4% vs 3.2%)
In a pragmatic RCT of patients with nonfatal opioid overdose, ED peer navigators did not reduce 1-year outcomes
This builds on a prior step-wedge cluster RCT: addiction consult increased med use, but 6-month retention was low & similar (2.4% vs 3.2%)
March 9, 2026 at 4:49 PM
Treating addiction is hard
In a pragmatic RCT of patients with nonfatal opioid overdose, ED peer navigators did not reduce 1-year outcomes
This builds on a prior step-wedge cluster RCT: addiction consult increased med use, but 6-month retention was low & similar (2.4% vs 3.2%)
In a pragmatic RCT of patients with nonfatal opioid overdose, ED peer navigators did not reduce 1-year outcomes
This builds on a prior step-wedge cluster RCT: addiction consult increased med use, but 6-month retention was low & similar (2.4% vs 3.2%)
Mild predialysis hyperkalemia may not warrant treatment
Among ESRD patients with a pre-dialysis K≥5.5, Lokelma improved long-term potassium control but did NOT reduce arrhythmia-related cardiovascular events (8.8% vs 8.9%)
The trial was stopped early for low event rates
Among ESRD patients with a pre-dialysis K≥5.5, Lokelma improved long-term potassium control but did NOT reduce arrhythmia-related cardiovascular events (8.8% vs 8.9%)
The trial was stopped early for low event rates
March 5, 2026 at 3:33 PM
Mild predialysis hyperkalemia may not warrant treatment
Among ESRD patients with a pre-dialysis K≥5.5, Lokelma improved long-term potassium control but did NOT reduce arrhythmia-related cardiovascular events (8.8% vs 8.9%)
The trial was stopped early for low event rates
Among ESRD patients with a pre-dialysis K≥5.5, Lokelma improved long-term potassium control but did NOT reduce arrhythmia-related cardiovascular events (8.8% vs 8.9%)
The trial was stopped early for low event rates
In a nationally representative sample of adults 41–76, almost all had abnormal shoulder MRI findings, including ~51% of asymptomatic individuals with partial-thickness rotator cuff tears
Like spine, knee, & hip imaging, this high prevalence suggests these are normal age-related
Like spine, knee, & hip imaging, this high prevalence suggests these are normal age-related
February 23, 2026 at 4:15 PM
In a nationally representative sample of adults 41–76, almost all had abnormal shoulder MRI findings, including ~51% of asymptomatic individuals with partial-thickness rotator cuff tears
Like spine, knee, & hip imaging, this high prevalence suggests these are normal age-related
Like spine, knee, & hip imaging, this high prevalence suggests these are normal age-related
Long-acting monthly injectable cabotegravir/rilpivirine was superior to oral ART in the LATITUDE trial among people with nonadherence, with an 18% absolute reduction in regimen failure
A prior small economic analysis from a safety-net clinic suggests it is cost-effective
A prior small economic analysis from a safety-net clinic suggests it is cost-effective
February 20, 2026 at 8:56 PM
Long-acting monthly injectable cabotegravir/rilpivirine was superior to oral ART in the LATITUDE trial among people with nonadherence, with an 18% absolute reduction in regimen failure
A prior small economic analysis from a safety-net clinic suggests it is cost-effective
A prior small economic analysis from a safety-net clinic suggests it is cost-effective
Up to 40% of hospitalized adults discharge to post-acute care at home or in a facility
This review demystifies post-acute care with a practical framework to match the right setting to a patient’s needs and plan for a smoother transition
This review demystifies post-acute care with a practical framework to match the right setting to a patient’s needs and plan for a smoother transition
February 10, 2026 at 3:21 PM
Up to 40% of hospitalized adults discharge to post-acute care at home or in a facility
This review demystifies post-acute care with a practical framework to match the right setting to a patient’s needs and plan for a smoother transition
This review demystifies post-acute care with a practical framework to match the right setting to a patient’s needs and plan for a smoother transition
In an open-label RCT of HIV-related sepsis in endemic TB regions, immediate anti-TB therapy reduced 28-day mortality in the subgroup with later microbiologically confirmed tuberculosis
This suggests, as with sepsis, that time to initiate anti-TB therapy might also matter
This suggests, as with sepsis, that time to initiate anti-TB therapy might also matter
February 6, 2026 at 7:31 PM
In an open-label RCT of HIV-related sepsis in endemic TB regions, immediate anti-TB therapy reduced 28-day mortality in the subgroup with later microbiologically confirmed tuberculosis
This suggests, as with sepsis, that time to initiate anti-TB therapy might also matter
This suggests, as with sepsis, that time to initiate anti-TB therapy might also matter
Consider single-dose amphotericin for cryptococcal meningitis
In a US safety-net hospital, the AMBITION regimen established in LMICs (single-dose liposomal ampho+flucy/fluc) achieved same outcomes with fewer severe adverse events in a pre-post analysis vs standard 14-day course
In a US safety-net hospital, the AMBITION regimen established in LMICs (single-dose liposomal ampho+flucy/fluc) achieved same outcomes with fewer severe adverse events in a pre-post analysis vs standard 14-day course
January 30, 2026 at 6:56 PM
Consider single-dose amphotericin for cryptococcal meningitis
In a US safety-net hospital, the AMBITION regimen established in LMICs (single-dose liposomal ampho+flucy/fluc) achieved same outcomes with fewer severe adverse events in a pre-post analysis vs standard 14-day course
In a US safety-net hospital, the AMBITION regimen established in LMICs (single-dose liposomal ampho+flucy/fluc) achieved same outcomes with fewer severe adverse events in a pre-post analysis vs standard 14-day course
Antibiotics hold up for more than half of patients with uncomplicated appendicitis, but decision to avoid upfront surgery is in the eye of the beholder
At 10-year follow-up, 44% eventually underwent an appendectomy
Greatest risk was in the first 12-18 months
At 10-year follow-up, 44% eventually underwent an appendectomy
Greatest risk was in the first 12-18 months
January 29, 2026 at 8:36 PM
Antibiotics hold up for more than half of patients with uncomplicated appendicitis, but decision to avoid upfront surgery is in the eye of the beholder
At 10-year follow-up, 44% eventually underwent an appendectomy
Greatest risk was in the first 12-18 months
At 10-year follow-up, 44% eventually underwent an appendectomy
Greatest risk was in the first 12-18 months
A 2023 narrative review challenges the centrality of dual-process models, arguing that diagnostic expertise matters more
Improving clinical reasoning may depend less on debiasing & more on richer problem representations, illness scripts & better access to the right knowledge
Improving clinical reasoning may depend less on debiasing & more on richer problem representations, illness scripts & better access to the right knowledge
January 24, 2026 at 4:25 PM
A 2023 narrative review challenges the centrality of dual-process models, arguing that diagnostic expertise matters more
Improving clinical reasoning may depend less on debiasing & more on richer problem representations, illness scripts & better access to the right knowledge
Improving clinical reasoning may depend less on debiasing & more on richer problem representations, illness scripts & better access to the right knowledge
For older adults w/ newly diagnosed afib during hospitalization the 1-yr stroke risk w/o anticoag was low: 0.7% for CHA2DS2VASc 1-4 & 1.8% for 5-8
Given consensus of ≥2%/year, anticoag may be less compelling in hospital-detected AF but should still be individualized by risk
Given consensus of ≥2%/year, anticoag may be less compelling in hospital-detected AF but should still be individualized by risk
January 23, 2026 at 7:45 PM
For older adults w/ newly diagnosed afib during hospitalization the 1-yr stroke risk w/o anticoag was low: 0.7% for CHA2DS2VASc 1-4 & 1.8% for 5-8
Given consensus of ≥2%/year, anticoag may be less compelling in hospital-detected AF but should still be individualized by risk
Given consensus of ≥2%/year, anticoag may be less compelling in hospital-detected AF but should still be individualized by risk
Best of Hospital Medicine in 2025
In article format...
In article format...
January 15, 2026 at 6:12 PM
Best of Hospital Medicine in 2025
In article format...
In article format...
Age-adjusted d-dimer cutoffs can safely exclude DVT
A multicenter prospective cohort found that 7% of imaging could be avoided by using this strategy over the standard d-dimer cutoffs
A multicenter prospective cohort found that 7% of imaging could be avoided by using this strategy over the standard d-dimer cutoffs
January 10, 2026 at 4:32 PM
Age-adjusted d-dimer cutoffs can safely exclude DVT
A multicenter prospective cohort found that 7% of imaging could be avoided by using this strategy over the standard d-dimer cutoffs
A multicenter prospective cohort found that 7% of imaging could be avoided by using this strategy over the standard d-dimer cutoffs
Prebiopsy steroids don’t reduce diagnostic yield in lymphoma (DLBCL)
A retrospective study confirmed biopsy type mattered most for yield (excisional > core >>> FNA)
A retrospective study confirmed biopsy type mattered most for yield (excisional > core >>> FNA)
January 9, 2026 at 5:59 PM
Prebiopsy steroids don’t reduce diagnostic yield in lymphoma (DLBCL)
A retrospective study confirmed biopsy type mattered most for yield (excisional > core >>> FNA)
A retrospective study confirmed biopsy type mattered most for yield (excisional > core >>> FNA)
Shunting in idiopathic NPH helps gait but with notable risks
In a placebo-controlled RCT of patients who improved with CSF drainage, shunting improved gait & reduced falls at 3 mos (24% vs 46%)
BUT more positional headaches (NNH 3), subdural bleeds (NNH 10) & hygromas (NNH 17)
In a placebo-controlled RCT of patients who improved with CSF drainage, shunting improved gait & reduced falls at 3 mos (24% vs 46%)
BUT more positional headaches (NNH 3), subdural bleeds (NNH 10) & hygromas (NNH 17)
December 20, 2025 at 4:37 PM
Shunting in idiopathic NPH helps gait but with notable risks
In a placebo-controlled RCT of patients who improved with CSF drainage, shunting improved gait & reduced falls at 3 mos (24% vs 46%)
BUT more positional headaches (NNH 3), subdural bleeds (NNH 10) & hygromas (NNH 17)
In a placebo-controlled RCT of patients who improved with CSF drainage, shunting improved gait & reduced falls at 3 mos (24% vs 46%)
BUT more positional headaches (NNH 3), subdural bleeds (NNH 10) & hygromas (NNH 17)
In a small but compelling proof-of-concept RCT in AUD, semaglutide reduced alcohol consumed vs placebo in a controlled setting where participants were presented with their preferred beverage
Also reduced several measures of self-reported consumption
Confirmatory trials needed
Also reduced several measures of self-reported consumption
Confirmatory trials needed
December 9, 2025 at 6:50 PM
In a small but compelling proof-of-concept RCT in AUD, semaglutide reduced alcohol consumed vs placebo in a controlled setting where participants were presented with their preferred beverage
Also reduced several measures of self-reported consumption
Confirmatory trials needed
Also reduced several measures of self-reported consumption
Confirmatory trials needed